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Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada

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Abstract

Assertive Community Treatment (ACT) model is the gold standard in community psychiatry serving people with severe mental illness. With its outreach-based design, the pandemic has profoundly affected the operations and functioning of ACT. The Dartmouth ACT Scale (DACTS) provides a standardized comprehensive and quantitative way to evaluate ACT quality. Results could inform nature of impact and identify areas for improvement. Current online survey used DACTS during the pandemic in April-May 2021. Clinical and administrative leadership of the 80 ACT teams in Ontario, Canada cross-sectionally rated ACT quality one-year pre-Covid (2018–2019) and one-year post the start of Covid (2020–2021). The overall pre-Covid Ontario ACT DACTS fidelity was 3.65. The pandemic led to decreases in all domains of DACTS (Human Resources: −4.92%, p < 0.001, 95% CI [0.08–0.27]; Organizational Boundary: −1.03%, p < 0.013,95%CI [0.01–0.07]; and Nature of Services: −6.18%, p < 0.001, 95%CI [0.16–0.26]). These changes were accounted by expected lower face-to-face encounters, time spent with clients, reduction in psychosocial services, less interactions with hospitals and diminished workforces. The magnitude of change was modest (−3.84%, p < 0.001, 95%CI [0.09–0.19]). However, the Ontario ACT pre-Covid DACTS was substantially lower (−13.5%) when compared to that from a similar survey 15 years ago (4.22), suggestive of insidious systemic level loss of fidelity. Quantitative fidelity evaluation helped to ascertain specific pandemic impact. Changes were significant and specific, but overall relatively modest when compared to the larger system level drop over the last decade. There is both evidence for model adaptability and resilience during Covid disruption, and concerns over larger downward drift in ACT fidelity and quality.

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Acknowledgements

The research team wishes to thank Ontario ACT and FACT Association members for supporting the survey. the research was supported by Alternative Funding Plan (AFP) COVID research grant from St. Michael’s Hospital, Unity Health, Toronto, Ontario, and Academic Scholar Award, Department of Psychiatry, University of Toronto.

Funding

The study was approved by the St. Michael’s Hospital, Unity Health Research and Ethics Board. The study was supported by the Ontario Academic Health Science Centre Alternative Funding Plan Innovations Funds; and in part by an Academic Scholars Award from the Department of Psychiatry, University of Toronto.

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Authors and Affiliations

  1. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Samuel Law, Aly Kassam & Saadia Sediqzadah

  2. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Samuel Law, Michaela Beder, Saadia Sediqzadah & Matthew Levy

  3. Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Samuel Law, Michaela Beder, Saadia Sediqzadah & Matthew Levy

  4. Canadian Mental Health Association, Barrie, ON, Canada

    John Maher

  5. Ontario Association of ACT and FACT, Toronto, ON, Canada

    John Maher

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All authors contributed to the conception, design and writing of this study. Material preparation, data collection and analysis were performed by Aly Kassam and Samuel Law. The first draft of the manuscript was written by Samuel Law and Aly Kassam, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Law, S., Kassam, A., Beder, M. et al. Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada. Adm Policy Ment Health (2024). https://doi.org/10.1007/s10488-024-01375-1

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